Provider Demographics
NPI:1396952107
Name:CLEMENT, GENEVA CHARLES (LCSW-R)
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:CHARLES
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HALL ST
Mailing Address - Street 2:1406
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-5045
Mailing Address - Country:US
Mailing Address - Phone:718-783-8312
Mailing Address - Fax:718-783-8312
Practice Address - Street 1:333 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5803
Practice Address - Country:US
Practice Address - Phone:718-522-6011
Practice Address - Fax:718-522-1560
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019088-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical